Healthcare Provider Details

I. General information

NPI: 1306392303
Provider Name (Legal Business Name): DANIELLE ZAUDERER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2016
Last Update Date: 02/10/2023
Certification Date: 02/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

134 N 4TH ST
BROOKLYN NY
11249-3296
US

IV. Provider business mailing address

10 BOND ST STE 463
GREAT NECK NY
11021-2454
US

V. Phone/Fax

Practice location:
  • Phone: 646-450-7748
  • Fax:
Mailing address:
  • Phone: 516-200-6003
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLICSW126128
License Number StateMA
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number090263
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: